Medical Records Request

Access to medical records is available to patient over the age of 18 or a legal guardian and is protected by federal HIPAA regulations.

Information for Patients, Parents, and Legal Guardians

Patients, parents and guardians who would like to receive a copy of their medical records should complete the Authorization to Disclose Medical Records Form here.

(Please note there is a $1.00 per page fee that must be paid in advance before your request will be processed. You will receive an invoice via email with a total amount due and instructions for payment once the request has been submitted through the link above).

To allow third-parties access to your records or your child’s medical records, please complete the Medical Records Release Form. Submit completed and signed forms to records@impowerfl.org or by fax to (321) 639-1194.

 

Information for Third Party Requestors

Third party requestors (healthcare providers, attorneys, insurance companies or other third parties) please submit a written request for the client’s medical records along with a signed patient authorization. You may fax to 321-639-1194 or email to records@impowerfl.org.  (Please note there is a $1.00 per page charge).

 

If you have additional questions, please contact Records Requests in our Outpatient Behavioral Health Program at (321) 639-1124 during normal business hours.